Population Health Management for Dual Eligibles: Blueprint for Care Coordination

Population Health Management for Dual Eligibles:
Blueprint for Care Coordination

Across the country, CMS is providing funding and technical support for select states to develop person-centered approaches to care coordination of dual eligibles, connecting primary, acute, behavioral health and long-term supports and services for beneficiaries of both Medicare and Medicaid.

The goal is to create care delivery and payment coordination models for this vulnerable population that can be piloted and replicated in other states.

Meanwhile, SCAN Health Plan has a history of successful care management of dual eligibles, who constitute about 9 million individuals in the United States. The not-for-profit California-based health plan has developed a multi-pronged, member-specific approach to reaching dual eligibles that has earned kudos from the healthcare industry.

Population Health Management for Dual Eligibles: Blueprint for Care Coordination details SCAN's unique care management model for duals, which focuses on prevention and early intervention, particularly in the area of medication management.

Developing relationships with long term care services and support providers to manage care for dual eligibles;

Integrating acute and long term care coordination; and

Metrics to follow in the dual eligible market.

Care coordination of dual eligibles has been identified by PricewaterhouseCoopers LLP as one of the top 10 healthcare priorities for 2013.

Also contributing to this special report is Hank Osowski, managing director of Strategic Health Group, who describes opportunities presented by the dual eligibles market in a post-ACA era. Many healthcare organizations are under intense pressure at the state and federal levels to find Medicaid and Medicare savings.

Osowski and several other thought leaders contribute their expertise to the Q&A portion of this resource.

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